| Debbie Malloy Llc | |
|
809 S Park St Ste 2 Carrollton GA 30117-4423 | |
| (678) 390-4218 | |
| Not Available |
| Full Name | Debbie Malloy Llc |
|---|---|
| Speciality | Counselor |
| Location | 809 S Park St Ste 2, Carrollton, Georgia |
| Authorized Official Name and Position | Lynette Clark (CREDENTIALING MANAGER) |
| Authorized Official Contact | 7703397667 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Debbie Malloy Llc 412 Sunset Blvd Carrollton GA 30117-4139 Ph: (678) 390-4218 | Debbie Malloy Llc 809 S Park St Ste 2 Carrollton GA 30117-4423 Ph: (678) 390-4218 |
| NPI Number | 1417410168 |
|---|---|
| Provider Enumeration Date | 04/10/2019 |
| Last Update Date | 07/29/2020 |
| Certification Date | 07/29/2020 |
| Medicare PECOS PAC ID | 5193162253 |
|---|---|
| Medicare Enrollment ID | O20240325002340 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417410168 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Debbie Malloy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1073906632 PECOS PAC ID: 7719324862 Enrollment ID: I20240325001999 |
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